Sba Form 413 - Personal Financial Statement
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5OMB APPROVAL NO. 3245-0188
EXPIRATION DATE: 09/30/2014
PERSONAL FINANCIAL STATEMENT
As of
,
U.S. SMALL BUSINESS ADMINISTRATION
Complete this form for: (I) each proprietor; (2) general partner; (3) managing member of a limited liability company (LLC); (4) each owner of 20% or more of the
equity of the Applicant (including the assets of the owner's spouse and any minor children); and (5) any person providing a guaranty on the loan.
Return completed form to:
7(a) loans - to the lender processing the SBA application;
504 loans - to the Certified Development Company processing the SBA application;
ALL Disaster loans - to the Disaster Processing and Disbursement Center at 14925 Kingsport Road, Fort Worth, TX 76155-2243; and
8(a)/BD - applicants who are individuals claiming social and economic disadvantaged status and their spouses
- electronically at or send hard copy with paper application to either of the two following offices listed below:
Mail to the following address, if your firm is
Mail to the following address, if your firm is
located in one of the states below:
located in one of the states below:
US Small Business Administration
DPCE Central Office Duty Station
US Small Business Administration
Parkview Towers
Division of Program Certification and Eligibility
1150 First Avenue
455 Market Street, 6th Floor
10th Floor, Suite 100I
San Francisco, CA 94105
King of Prussia, PA 19406
MA, ME, NH, CT, VT, RI, NY, PR (Puerto Rico), VI (US Virgin
IL, OH, MI, IN, MN, WI, TX, NM, AR, LA, OK, MO, IA, NE, KS, CO,
Islands), NJ, PA, MD, VA, WV, DC, DE, GA, AL, NC, SC, MS,
WY, ND, MT, UT, SD, CA, HI, GU (GUAM), NV, AZ, WA, AK, ID,
FL, KY, TN
OR
Name
Business Phone
Residence Address
Residence Phone
City, State, & Zip Code
Business Name of Applicant/Borrower
LIABILITIES
ASSETS
(Omit Cents)
(Omit Cents)
$
Cash on hand & in Banks
$
Accounts Payable
Savings Accounts
$
$
Notes Payable to Banks and Others
IRA or Other Retirement Account
$
(Describe in Section 2)
(Describe in Section 5)
Installment Account (Auto)
$
Accounts & Notes Receivable
Mo. Payments
$
$
(Describe in Section 5)
Installment Account (Other)
$
Life Insurance-Cash Surrender Value Only
$
Mo. Payments
$
(Complete Section 8)
$
Loan on Life Insurance
Stocks and Bonds
$
$
Mortgages on Real Estate
(Describe in Section 3)
(Describe in Section 4)
Real Estate
$
$
(Describe in Section 4)
Unpaid Taxes
Automobiles - Total Present Value
(Describe in Section 6)
$
(Describe in Section 5, and include
Other Liabilities
$
Year/Make/Model)
(Describe in Section 7)
Other Personal Property
$
$
Total Liabilities
(Describe in Section 5)
$
Net Worth
Other Assets
$
(Describe in Section 5)
$
Total
Total
$
Section 1.
Source of Income
Contingent Liabilities
$
$
Salary
As Endorser or Co-Maker
Net Investment Income
Legal Claims & Judgments
$
$
$
$
Real Estate Income
Provision for Federal Income Tax
Other Income (Describe below)*
$
Other Special Debt
$
Description of Other Income in Section 1.
*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.
SBA Form 413 (05-12) Previous Editions Obsolete
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